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Background/Aim: Adult-onset Still’s disease (AOSD) is a multi-systemic, autoinflammatory disorder. Several activity scores have been proposed but none of them have been adopted universally. Our aim was to create a clinician-friendly activity scoring system by using simple clinical and laboratory parameters. Methods: AODS patients according to Yamaguchi criteria were included in this cross-sectional, multi-center study. Derivation and validation cohorts were constituted. Demographic, clinical and laboratory evaluation at study visit; patients’, and physicians’ global assessments of disease activity (both VAS/ Likert scale) were recorded. To develop the score; ordinal logistic regression model was used to determine independent predictors of patient’ global assessments of disease activity. Clinically and statistically significant variables were weighted according to regression coefficients. Then, performance of the score was tested on the validation cohort. Results: Total of 197 consecutive AOSD patient (125 in derivation, 72 in validation cohorts) were included. Final Still Activity Score was fever (2 points), arthralgia (2 points, plus 1 point if arthritis was present in ≥2 joints), neutrophilia≥65% (1 point) and ferritin≥350 ng/mL (1 point) (maximum of 7 points). The SAS yielded an AUC value of 0.98(0.96-1.00) in the derivation cohort and 0.91(95%CI:0.85-0.98) in the validation cohort to discriminate high AOSD activity from moderate-inactive AOSD. Correlation of SAS with PtGA was 83% for the derivation cohort and 76% for the validation cohort. Conclusions: SAS has shown a good test performance to distinguish active AOSD patients from the others. SAS may be a useful method for evaluating disease activity of AOSD patients in daily practice. Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: The present study was conducted in compliance with the Helsinki Declaration and was approved by the Local Ethics Committee of Hacettepe University (GO- 20/824). A written informed consent form was completed by all participants.

Background/aim: to evaluate treatment adherence and predictors of drug discontinuation among patients with inflammatory arthritis receiving bDMARDs within the first 100 days after the announcement of the COVID-19 pandemic. Materials and methods: a total of 1871 patients recorded in TReasure registry for whom advanced therapy was prescribed for rheumatoid arthritis (RA) or spondyloarthritis (SpA) within the 3 months (6-9 months for rituximab) before the declaration of COVID-19 pandemic were evaluated, and 1394 (74.5%) responded to the phone survey. Patients' data regarding demographic, clinical characteristics and disease activity before the pandemic were recorded. The patients were inquired about the diagnosis of COVID-19, the rate of continuation on bDMARDs, the reasons for treatment discontinuation, if any, and the current general disease activity (visual analog scale, [VAS]). Results: a total of 1394 patients (493 RA [47.3% on anti-TNF] patients and 901 SpA [90.0% on anti-TNF] patients) were included in the study. Overall, 2.8% of the patients had symptoms suggesting COVID-19, and 2 (0.15%) patients had PCR-confirmed COVID-19. Overall, 18.1% of all patients (13.8% of the RA and 20.5% of the SpA; p = 0.003) discontinued their bDMARDs. In the SpA group, the patients who discontinued bDMARDs were younger (40 [21-73] vs. 44 years [20-79]; p = 0.005) and had higher general disease activity; however, no difference was relevant for RA patients. Conclusion: although the COVID-19 was quite uncommon in the first 100 days of the pandemic, nearly one-fifth of the patients discontinued bDMARDs within this period. The long-term effects of the pandemic should be monitored., Hacettepe Rheumatology Society

COVID-19 pandemic affected the world in many ways. Internal medicine education needed to be shaped according to the requirements of this pandemic. The aim of this study is to understand the effect of COVID-19 pandemic on internal medicine education and evaluate the newly introduced methods for education. Fourth-year medical students of 2019-2020 and 2020-2021 academic terms are evaluated in this study. Exam results and feedback scores of students are obtained. Assessment methods in pre-pandemic group are face-to-face written exam and OSCE exam, whereas in post-pandemic group, online written exam and OSCE exam are used. Feedback forms are the same in both groups. The median written exam score was higher in the post-pandemic group than in the pre-pandemic group (84 vs 80, respectively, p = 0.003). There is no statistical significance among OSCE exam grades of the two groups. Feedback scores for bedsides were slightly higher in the post-pandemic group, and there is no statistical significance. Written and OSCE exam results in the post-pandemic group were as good as in the pre-pandemic group. We realized that the learning objectives in classical lecture can also be achieved from video recordings. Although not statistically proven, we claim that increasing the time spent in clinical practice will yield more experience to the students.

Objective: Metabolic syndrome (MetS) is one of the preventable risk factors for cardiovascular disease (CVD). The aim of this study was to investigate the effect of MetS on CVD and cumulative organ damage in a multi-center, large cohort of patients with Takayasu arteritis (TAK). Methods: This is a cross-sectional study involving 192 consecutive TAK patients from seven tertiary rheumatology centers in Turkey. Clinical data of TAK patients fulfilling the 1990 American College of Rheumatology classification criteria were collected from medical records. They were evaluated for risk factors of CVD, disease activity, damage, and MetS at their last visits. Results: A total of 192 consecutive TAK patients were included in this study. One hundred and fifty-eight (82%) were female, the mean age was 43.3 +/- 13 years, and mean disease duration was 13.5 +/- 9.3 years. MetS was detected in 50 (26%) of the patients and CVD was detected in 28 (14.6%). The presence of MetS was detected as an independent risk factor for CVD (P < 0.001). In addition, the mean vasculitis damage index of the group with MetS was significantly higher than in the other patients (4.5 +/- 3.3 vs 3.2 +/- 2.2, respectively, P = 0.004). Conclusion: The presence of MetS in TAK is associated with increased CVD and disease damage. Awareness and management of MetS can improve disease prognosis in patients with TAK.

This study aimed to compare Tuberculin Skin Test (TST) and QuantiFERON (R)-TB Gold In-Tube (QFT-GIT) test in rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients scheduled for biological and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) in a Bacillus Calmette-Guerin-vaccinated population. Adult RA (n = 206) and SpA (n = 392) patients from the TReasure database who had both TST and QFT-GIT prior to initiation of biological and targeted synthetic DMARDs were included in the study. Demographic and disease characteristics along with pre-biologic DMARD and steroid use were recorded. The distribution of TST and performance with respect to QFT-GIT were compared between RA and SpA groups. Pre-biologic conventional DMARD and steroid use was higher in the RA group. TST positivity rates were 44.2% in RA and 69.1% in SpA for a 5 mm cutoff (p < 0.001). Only 8.9% and 15% of the patients with RA and SpA, respectively, tested positive by QFT-GIT. The two tests poorly agreed in both groups at a TST cutoff of 5 mm and increasing the TST cutoff only slightly increased the agreement. Among age, sex, education and smoking status, pre-biologic steroid and conventional DMARD use, disease group, and QFT-GIT positivity, which were associated with a 5 mm or higher TST, only disease group (SpA) and QFT-GIT positivity remained significant in multiple logistic regression. TST positivity was more pronounced in SpA compared to that in RA and this was not explainable by pre-biologic DMARD and steroid use. The agreement of TST with QFT-GIT was poor in both groups. Using a 5 mm TST cutoff for both diseases could result in overestimating LTBI in SpA.

Objective Because of concerns about malignancy risks, using biological disease-modifying antirheumatic drugs (bDMARDs) in patients with a history of malignancy remains a challenging issue in rheumatology practice. This study aimed to investigate bDMARD preferences of physicians when treating of rheumatoid arthritis (RA) and spondyloarthritis (SpA) patients with a history of malignancy. Methods The data for this cross-sectional study were gathered from the TReasure database using a date range of December 2017 and January 2020. Biological disease-modifying antirheumatic drug preferences were analyzed for 40 RA patients and 25 SpA patients with a history of malignancy. Results The most frequently prescribed bDMARD was rituximab, which was given to 28 RA patients (70%). For 25 patients (62.5%), the time between the diagnosis of malignancy and starting on a bDMARD regimen was less than 60 months, with a median interval of 43.5 months. Among SpA patients, the preferred bDMARDs were secukinumab and etanercept, which were each administered to 7 patients (28%). For 13 SpA patients (52%), the time between the diagnosis of malignancy and starting on bDMARDs was less than 60 months, with a median interval of 97 months. Conclusions The observed bDMARD preferences may be related to the therapeutic effects of rituximab on lymphoproliferative malignancies, the protective effects of secukinumab on tumor progression, and the short half-life of etanercept. Biological disease-modifying antirheumatic drugs should be used in RA and SpA patients with malignancy in case of high inflammatory activity.

We wanted to see how close we could get to our goal of treating rheumatoid arthritis (RA) without the use of glucocorticoids (GCs) in the disease-modifying antirheumatic drugs (DMARDs) era using real-life data. Established in 2017, the TReasure database is a web-based, prospective, observational cohort for Turkey. As of May 2019, there were 2,690 RA patients recorded as receiving biologic and targeted synthetic DMARDs (bDMARDs and tsDMARDs) therapy. At the start of the bDMARDs or tsDMARDs, patients with follow-up visits of at least 3 months were registered. At the time of registration and the last visit, doses of GCs were recorded and it was determined if the target dose of ≤ 7.5 mg was achieved. During registration and follow-up, 23.4% of the patients did not receive GCs and 76.5% of the patients received GCs at any time. GCs could be stopped after 59 (25–116) months in 28.4% of these patients, but 71.6% of patients were still using GC. The target GC dose could not be achieved in 18.2% of these patients (n = 352). The rate of continuing to use GC was significantly higher in women, in the elderly, those with rheumatoid factor (RF) positive, with higher Visual Analog Scale (VAS) pain and Disease Activity Score (DAS)-28. The initial GC dose of ≥ 7.5 mg/day was found to be crucial in not reaching the GC target dose (p

Objective: we have conducted this study to evaluate clinical and laboratory findings and to gather and evaluate information that would be useful in clinical practice, such as demographics, joint involvement patterns, laboratory anomalies, treatments applied, and responses obtained in patients diagnosed with gout. Methods: in our study, the demographic, clinical, and laboratory characteristics of 94 patients diagnosed with gout were evaluated. The patients were re-evaluated with regard to their clinical and laboratory findings at the end of the 1st and 3rd months, their responses to the treatment were observed, and where necessary, new treatment adjustments were made. Results: seventy-nine (84%) of the patients were men, and 15 (16%) were women. The ages of the patients ranged between 22 and 86 years with the average age being 57.5 years. The joint involvement during a gouty arthritis attack was most frequently observed in the 1st metatarsophalangeal joint (87.2%), followed by the ankle joint (26.9%), and the knee joint (23.7%). The joint involvement pattern was evaluated to reveal that the acute monoarticular arthritis was observed in 87 patients (93.5%), followed by acute oligoarticular arthritis coming in second in terms of frequency (26.9%). An average attack was determined to last 10.7 days, and the average number of attacks in a year was 2.69. In our study, the colchicine treatment in 24 of our patients, in whom it was determined during the admission and follow-up process that they have not had gouty arthritis attack in the past 3 months, was stopped. Five (20.8%) patients whose colchicine treatment was stopped later developed gouty arthritis attacks, and the colchicine treatment was restarted. On the other hand, 10 out of 38 patients (26.3%), who have either been continuing or had never been on colchicine treatment, were observed to experience a gouty arthritis attack during their 1st and 3rd month check-ups. Conclusion: In patients with gout, it is recommended that the related diseases, as well as the triggering factors (alcohol, drug use, and dietary effect), be determined, the necessary lifestyle changes be made, and the treatments started., NA

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Objective: To compare the treatment outcomes of TNF inhibitors and tocilizumab (TCZ) in patients with Takayasu arteritis. Methods: Takayasu arteritis patients who were refractory to conventional immunosuppressive (IS) drugs and received biologic treatment were included in this multicenter retrospective cohort study. Clinical, laboratory and imaging data during follow-up were recorded. Remission, glucocorticoid (GC) sparing effect, drug survival was compared between TNF inhibitor and TCZ treatments. Also, a subgroup matched comparison was performed between groups. Results: One hundred and eleven (F/M: 98/13) patients were enrolled. A total of 173 biologic treatment courses (77 infliximab, 49 TCZ, 33 adalimumab, 9 certolizumab, 3 rituximab, 1 ustekinumab and 1 anakinra) were given. Tocilizumab was chosen in 23 patients and TNF inhibitors were chosen in 88 patients as first line biologic agent. Complete/partial remission rates between TCZ and TNF inhibitors were similar at 3rd month and at the end of the follow-up. GC dose decrease (

Background: Throughout the pandemic, physicians working at the frontlines have embarked on various quests to protect themselves, and many physicians preferred the use of hydroxychloroquine (HQN) as a prophylactic agent. This study aimed to investigate the reasons leading physicians to use HQN and the effects of HQN use on physicians.Methods: This study is a cross-sectional study with a target population of physicians working in pandemic hospitals in İstanbul, Turkey. We have recruited the participants from seven different hospitals via an invitation email between May 14 and June 13, 2020. An online questionnaire, including 57 questions in total, was sent to each physician.Results: A total of 148 (26%) physicians used hydroxychloroquine for prevention. Older physicians and ones who have a story of exposure to COVID-19 patients without any protection used more prophylactic HQN. Hydroxychloroquine did not differ statistically in terms of being infected among the exposed physicians (p=0.52). Nineteen (13%) physicians using hydroxychloroquine developed side effects related to the drug. Diarrhea and nausea were the most common.Conclusion: Prophylactic HQN use was more common among the physicians older than 40 years and who had higher exposure rates to a COVID-19 patient without any protection. The physicians working at the frontlines had the highest rate of infection. Hydroxychloroquine was not effective in the prophylaxis of COVID-19 among the exposed physicians.

Background: Several societies published recommendations for latent tuberculosis infection (LTBI) screening before biological and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) but not for other inflammatory arthritides such as spondyloarthritis (SpA). Using RA guidelines could result in overestimating Tuberculin Skin Test (TST) positivity in SpA. This study aimed to compare the distribution of TST results in SpA and RA patients along with comparison in terms of QuantiFERON®-TB Gold In-Tube (QFT-GIT) test in a Bacillus Calmette-Guérin-vaccinated population.Methods: Adult RA (n=206) and SpA (n=392) patients from the TReasure database who had both TST and QFT-GIT prior to initiation of biological and targeted synthetic DMARDs were included in the study. Demographic and disease characteristics along with pre-biologic DMARD and steroid use were recorded. The distribution of TST and performance with respect to QFT-GIT were compared between RA and SpA groups.Results: Pre-biologic conventional DMARD and steroid use was higher in the RA group. TST positivity rates were 44.2% in RA and 69.1% in SpA for a 5 mm cut-off (pConclusions: TST positivity was more pronounced in SpA compared to that in RA and this was not explainable by pre-biologic DMARD and steroid use. The agreement of TST with QFT-GIT was poor in both groups. Using a 5 mm TST cut-off for both diseases could result in overestimating LTBI in SpA.

Rheumatoid arthritis (RA) prevalence increases with age and old people are special patient population. The recognition of functional disability related to RA could be challenging in elderly patients because aging itself and potential co-morbid disease may also cause functional disability. In this study, we aimed to look at the correlation between disease activity and functional disability in elderly RA patients. Elderly RA patients, ≥65 years old at their routine visits were included in the study. The composite 'disease activity score' in 28 joints (DAS-28) was used to determine disease activity groups. Health assessment questionnaire (HAQ) scores were calculated to describe the functional disability and compared across the disease activity groups. Two hundred and fifty-eight RA patients with the mean age of 71 ± 5 (65-90) and a total disease duration of 8.4 ± 8.5 (.5-50) years were recruited. The proportion of patients with high and moderate disease activity was 70%. HAQ scores were significantly correlated with disease activity (p .05). Functional disability estimated by HAQ was correlated with disease activity in elderly patients with RA.

Rheumatoid nodules are the most common pulmonary manifestations of rheumatoid arthritis (RA) and are usually asymptomatic. In rare cases, they progress cavitary formation and cause severe clinical symptoms because of disease activity, infectious diseases, and other etiologies. The determination of clinical and histopathological features may be helpful for differential diagnosis in patients with RA with cavitary pulmonary nodules. Herein, we report two female patients with RA with cavitary pulmonary nodules and aim to obtain more detail data by means of reviewing previously reported cases.

Background:Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease mainly affecting sacroiliac joints and spine. Peripheral arthritis, dactylitis and enthesitis may also occur. Extra musculoskeletal manifestations (EMMs; uveitis [AAU], inflammatory bowel disease [IBD] and psoriasis [Pso] are among the most common ones) are important features and might have an impact on the disease burden in patients with axSpA. The presence of EMM, in particular IBD and AAU could influence the choice of TNFi however little is known regarding the role of peripheral manifestations together with the EMM on the prescribing patterns in axSpA patients.Objectives:To examine the frequency of peripheral and EMMs in a real-world axSpA cohort and their effect on the choice of first advanced treatment.Methods:In total 1687 axSpA patients (58% male and the mean age (±SD) was 38.5 ± 10.9) who initiated his/her first biologic were included in the present analysis. The data for the current study was obtained from the TReasure web-based registry; in which RA and SpA patients treated with bDMARDs from different regions of Turkey. Baseline demographic, disease related characteristics, peripheral and EMMs were extracted. Characteristics of patients with and without peripheral/extra-musculoskelatal involvement were compared as well as factors/covariates associated with the choice of first TNFi and secukinumab was analysed.Results:Enthesis (28.2%) was found the most common peripheral manifestations and peripheral arthritis (26.4%) and hip arthritis (24.4%) followed it. Symptom duration to the first advanced treatment initiation was significantly shorter in axSpA patients with peripheral arthritis, enthesitis, dactylitis and psoriasis and longer in hip arthritis and AAU. HLA-B27 positivity was significantly lower in patients with arthritis, psoriasis and IBD and higher with hip arthritis and AAU. In multivariate analysis the presence of IBD is significantly associated with the preference of monoclonal TNFi (mab) over etanercept (ETA) (OR 5,770; 95%CI 1.788-18.616). However ETA was preferred in patients with hip arthritis (p=0.003), longer symptom duration (p=0.049), and using sulfasalazine (p=0.043). In comparison with mabs, secukinumab (SEC) prescription was found to be significantly associated with higher age (p=0.001), sulfasalazin (p=0.001) and methotrexate usage (p=0.053) among axSpA patients need their first advanced treatment.Conclusion:The results of the current study confirm the pathophsyologic associations of peripheral involvement and EMM in axSpA patients. Apart from hip arthritis the presence of IBD has an impact on the prescription of advanced treatment in real-life.Table 1.Clinical characteristics of patients in cohortAll patients(n=1678)Peripheral arthritis(n=445)Dactilitis(n=81)Enthesis(n=476)Uveitis(n=193)Psoriazis(n=152)IBD(n=78)Hip involvemet(n=412)Age, mean±SD38,5±10,938,3±11,637,4±11,137,9±10,741,3±11,439,9±11,341,6±12,239,2±11,2Male sex,n (%)974 (57,7)184 (41,3)34 (42)238 (50)96 (49,7)54 (35,5)43 (55,1)272 (66)Symptom duration, mean month±SD108,5±98,996,9±92,979,1±76,5100,4±92,7144,7±110,287,7±9494,5±98133,3±108,2HLA B27 positivity, n (%)621 (53,7)142 (46,3)27 (51,9)174 (49,4)104 (77)34 (36,2)16 (27,1)186 (59,8)Concomitant cDMARD usage (yes), n (%)420 (24,9)170 (38,2)39 (48,1)133 (27,9)53 (27,5)58 (38,2)24 (30,8)99 (24)BASDAİ,mean±SD5,1±2,55,1±35,3±3,15,3±2,94,7±2,55,6±2,44,8±2,35,3±2,1ASDAS-CRP, mean±SD3,1±1,52,6±1,92,5±1,82,8±1,72,9±1,73,4±1,33,1±1,53,7±1,4Disclosure of Interests:None declared

Background: Articular manifestations may differ in ulcerative colitis (UC) and Crohn’s disease (CD). Genetic and non-genetic factors like sex, smoking, and presence of HLA-B27 were previously shown to modify the expression of articular and other extraintestinal manifestations of IBD. Objectives: The aim of this study is to document disease features and factors affecting the expression of articular manifestations in Turkish patients with IBD-related (enteropathic) arthritis under treatment with disease modifying antirheumatic drugs (DMARDs). Methods: Data regarding enteropathic arthritis (EA) were collected from the TReasure database, a nation-wide multicenter observational registry of inflammatory arthritis patients. Results: Among 4066 patients with seronegative spondyloarthropaties (SpA), 156 (3.8%) had EA, not reflecting a true prevalence due to selection bias. Demographic and clinical features according to IBD groups were summarized in Table 1. Rates of presence of sacroiliitis were similar between patients with UC and CD (39.9% and 60.1%, p=0.086 respectively). Rates of HLA-B27 positivity were 31.6% and 7.1% in patients with and without radiographic sacroiliitis, respectively (p=0.101). Enthesitis, dactylitis, psoriasis, family history forSpA, ESR, CRP, BASDAI and aSDAS levels had similar distributions in patients with and without radiographic sacroiliitis. Rates of “never-smoked” (26.5% vs 64.7%) and “current smoking” (32.4% vs 17.6%) significantly differed in patients with and without sacroiliitis (overall p=0.012) Conclusion: Our data confirm an association between smoking status and disease manifestations, particularly radiographic sacroiliitis. References [1] Fries W. Clinical features and epidemiology of spondyloarthritides associated with inflammatory bowel disease. World J Gastroenterol2009; 15: 2449-2455. Disclosure of interests: Orhan Kucuksahin: None declared, abdulsamet Erden: None declared, Ufuk Ilgen: None declared, Sedat Kiraz: None declared, ali Ihsan Ertenli: None declared, Nazife Sule Yasar Bilge: None declared, Timucin Kasifoglu: None declared, Ediz Dalkilic Grant/research support from: MSD and abbvie, Consultant for: MSD, abbvie,Roche, UCB, Pfizer and Novartis, Speakers bureau: MSD, abbvie,Roche, UCB, Pfizer and Novartis, Cemal Bes: None declared, Nilufer alpay Kanitez: None declared, Hakan Emmungil Grant/research support from: MSD, Roche, Pfizer, abbvie, Consultant for: Novartis, Roche, Speakers bureau: MSD, Roche, Pfizer, abbvie,Celltrion, Novartis, Pamir atagunduz: None declared, Belkis Nihan Seniz: None declared, Burcu Yagiz: None declared, Suleyman Serdar Koca: None declared, Muhammet Cinar: None declared, askin ates: None declared, Servet akar Grant/research support from: MSD, abbvie, Roche, UCB, Novartis, Pfizer, amgen, Consultant for: MSD, abbvie, Roche, UCB, Novartis, Pfizer, amgen, Speakers bureau: Pfizer, Onay Gercik: None declared, Duygu Ersozlu: None declared, Veli yazisiz: None declared, Gezmis Kimyon: None declared, Muge aydin: None declared, Ridvan Mercan: None declared, Burak Oz: None declared, Zeynel abidin akar: None declared, Omer Karadag: None declared, Bahar Kelesoglu: None declared, Sedat Yilmaz: None declared, Yavuz Pehlivan: None declared, Ender Terzioglu: None declared, Levent Kilic: None declared, Sukran Erten: None declared, Koray Tascilar: None declared, Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, abbvie, Roche, UCB, Novartis, Pfizer and abdi Ibrahim, Speakers bureau: MSD, abbvie, Roche, UCB, Novartis, Pfizer and abdi Ibrahim

Background: As a result of arterial ischemia, the frequencies of hypertension (HT), ischemic heart disease, congestive heart failure and atherosclerosis have been shown to increase and contribute to mortality in patients with Takayasu’s arteritis (TAK). Determining cardiovascular disease (CVD) and associated risk factors in TAK is important for a comprehensive treatment approach and better disease prognosis. Data about the effect of metabolic syndrome (MetS) which is known as a risk factor for CVD on TAK are limited. Objectives: The aim of this study was to determine the prevalence of MetS in patients with TAK and its effect on CVD and cumulative organ damage. Methods: A total of 122 TAK patients, followed by Turkish Takayasu Study Group in 7 tertiary Centers and diagnosed according to the 1990 ACR criteria were consecutively assessed for cumulative organ damage (VDI score), history of CVD and MetS as defined by the National Cholesterol Educational Program Adult Treatment Panel III (NCEP ATP III). CVD was defined as coronary artery disease or cerebrovascular event (myocardial infarction or stroke). Results: Eighty-seven percent of patients were female and the median age was 39 (17-65) years. The frequency of MetS was 14.7% and CVD was 13.1%. The median age, disease duration, smoking prevalence and CVD were found slightly higher in MetS group, without reaching statistical significance. There were no differences in VDI score between the groups (Table 1). Conclusion: MetS frequency in our TAK patients was observed to be less than the normal population data obtained from METSAR (Turkish MetS study in normal population) in Turkey (female: 39.6%, male: 28%). The discrepancy with SLE, which is another inflammatory autoimmune disease having a higher frequency of MetS related with organ damage, may be explained with the potentially more severe disease course in SLE patients requiring higher cumulative doses of glucocorticoids (1). Reference [1] Demir S, Artim-Esen B, Sahinkaya Y, Pehlivan O, Alpay-Kanitez N, Omma A, et al. Metabolic syndrome is not only a risk factor for cardiovascular diseases in systemic lupus erythematosus but is also associated with cumulative organ damage: a cross-sectional analysis of 311 patients. Lupus. 2016;25:177-84. Disclosure of Interests: Nilufer Alpay Kanitez: None declared, Sema Kaymaz Tahra: None declared, Ayten Yazici: None declared, Ayse Cefle: None declared, Mete Kara: None declared, Handan Yarkan-Tugsal: None declared, Onay Gercik: None declared, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Fatos Onen: None declared, Kenan Aksu: None declared, Gokhan Keser: None declared, Cemal Bes: None declared, Sevil Kamali: None declared, Fatma Alibaz-Oner: None declared, Haner Direskeneli: None declared

Background: In rheumatoid arthritis (RA), biologic DMARDs are important treatment options in resistant patients. Inefficacy or side effects may cause switching between these drugs. Objectives: This study aimed to determine features of patients switching from one biologic DMARD to another in RA treatment and to investigate associated reasons for switching. Methods: This multicenter, prospective observational cohort study used the TReasure database in which web-based registration of RA and spondyloarthritis patients are being performed in 15 centers across different regions of Turkey. In this study, data of RA patients switching from one biologic agent to another were analyzed. Demographic and clinical data, follow-up duration, time to switch, and reasons for switching were retrieved from the database. Results: Of the included 2115 RA patients, 829 (39.2%) switched between biologic agents (switched group) and 1286 (60.8%) continued to receive their current therapies (continued group). The median follow-up duration of all patients was 3.7 years and the median time to switch was 1.1 years. In the switched group, the proportion of females and the median HAQ-DI score were higher as well as disease duration was longer (Table 1). Among the biologic agents used at first, 60.9% of the patients were receiving an anti-TNF agent and 39.1% of the patients were receiving other biologic agents (Table 2, figure 1). In the switched group (n=829), the main reasons for switching were secondary inefficacy (n=269), primary inefficacy (n=238), and side effects (n=178) followed by primary or secondary unknown inefficacy (n=30), patient’s demand (n=21), physician’s request (n=16), willing to be pregnant (n=7), other (n=31), and unknown (n=54). Conclusion: The patients in the Treasure database were followed-up approximately 4 years and about one-third of the patients had to switch from one biologic DMARD to another. The main reasons for this switching were primary (29.2%) and secondary (33.0%) inefficacy and 20% of the patients had to switch due to side effects. According to the switching pattern, about half of the patients using an anti-TNF agent at first switched to another anti-TNF agent and the other half switched to other biologic agents. Disclosure of Interests: Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Speakers bureau: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Ali Ihsan Ertenli: None declared, Abdulsamet Erden: None declared, Orhan Kucuksahin: None declared, Timucin Kasifoglu: None declared, Ediz Dalkilic Grant/research support from: MSD and Abbvie, Consultant for: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Speakers bureau: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Cemal Bes: None declared, Nilufer Alpay Kanitez: None declared, Hakan Emmungil Grant/research support from: MSD, Roche, Pfizer, Abbvie, Consultant for: Novartis, Roche, Speakers bureau: MSD, Roche, Pfizer, Abbvie,Celltrion, Novartis, Pamir Atagunduz: None declared, Belkis Nihan Coskun: None declared, Burcu Yagiz: None declared, Suleyman Serdar Koca: None declared, Muhammet Cinar: None declared, Askin Ates: None declared, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Onay Gercik: None declared, Duygu Ersozlu: None declared, Veli Yazisiz: None declared, Gezmis Kimyon: None declared, Muge Aydin: None declared, Ridvan Mercan: None declared, Burak Oz: None declared, Nazife Sule Yasar Bilge: None declared, Zeynel Abidin Akar: None declared, Omer Karadag: None declared, Ayse Bahar Kelesoglu Dincer: None declared, Sedat Yilmaz: None declared, Ufuk Ilgen: None declared, Yavuz Pehlivan: None declared, Ender Terzioglu: None declared, Levent Kilic: None declared, Sukran Erten: None declared, Sedat Kiraz: None declared

Background Familial Mediterranean fever (FMF) is an autosomal recessively inherited autoinflammatory disease and begins in childhood. In nearly 60% of patients, the first attack occurs before the age of 10, and in 90% of them before the age of 20 years. There isn’t a prospective study designed for comparing childhood onset and adult onset FMF. Objectives To compare the demographic data, clinical features, genetic analysis, laboratory values and severity scores of both childhood and adult onset FMF. Compliance and resistance to colchicine, presence of accompanying diseases and complications due to FMF were also analyzed and reviewed. Methods The patients were divided into two groups; group I: children with FMF (symptoms begin before 18 years of age) and group II: adults with FMF (symptoms begin after 18 years of age). A questionnaire for collecting age at disease onset, sex, age at diagnosis, delay at diagnosis and duration of the disease, family history of FMF, consanguinity and accompanying diseases were filled. The questions were asked by an adult and pediatric rheumatologist to both groups by face to face interviews. Genetic analysis results and treatment protocols were taken from patient’s charts. Laboratory data concerning complete blood count, ratio of urine protein to creatinine, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), serum amyloid A (SAA) levels were obtained during their routine follow-up at attack-free period. Results There were 178 (60.3%) children with the diagnosis of FMF; 73 female and 104 male and 117 (39.7%) adults diagnosed as FMF after 18 years of age; 69 female and 48 male. The mean±SD age at symptom onset, at the diagnosis and current age was 4.92±3.03, 6.45±3.61, 11.59±4.38 for group I and was 18.35±10.34, 32.23±11.62, 38±11.64 for group II, respectively. Consanguinity was significantly more frequent among children with FMF (36.1%). A positive family history of FMF was similarly present in 102 (57.6%) of group I and 66 (56.4%) of group II. Twelve (10.2%) adult patient have FMF at their children. Family history of amyloidosis was equally distributed between groups; 6.2% in group I and 6.8% in group II. The median number of FMF attacks per year was 18 in children and 15 in adults. While children were having significantly more frequent attacks, the duration of attacks were longer in adults compared to children (p Conclusion Both clinical features and acute phase response in FMF were less pronounced in patients diagnosed at adulthood. Children were having more frequent attacks,but accompanying diseases were more common in adults. While following patients taking age of the patient in to account will help to better understand the disease course. Reference [1] Yasar Bilge NS, Sari I, Solmaz D, et al. Comparison of early versus late onset familial Mediterranean fever. Int J Rheum Dis. 2018 Apr;21(4):880-884. doi: 10.1111/1756-185X.13259. Epub 2018 Jan 5. Acknowledgement None Disclosure of Interests None declared

Background Takayasu’ arteritis (TAK) is a rare vasculitis characterized by inflammation and obliteration of intermediate to large-size arteries. Even though more than 50% of patients with TAK have pulmonary artery involvement, non-vascular involvement and symptoms are uncommon. Objectives We aimed to investigate the frequency of non-vascular pulmonary involvement in TAK. Methods We assembled a retrospective cohort of patients with TAK from six different centers in Turkey. The demographics, clinical characteristics, treatment and outcomes of patients were abstracted from medical records, and the computed tomography findings were evaluated for pulmonary manifestations. Results As of January 2019, 197 TAK patients were recruited (mean age: 42.7±13.9 years [min-max: 17-75]) to the cohort, and 88.3% of them were female. Twenty-four patients had cough and/or dyspnea and four had hemoptysis as pulmonary symptoms. In CT assessment, parenchymal infiltrations were present in four (2%), pleural effusion in five (2.5%), nodule/cavity in one (0.5%), and pulmonary hemorrhage in one patient (0.5%). The patient who had pulmonary hemorrhage had also pleural effusion at the same time. In the whole cohort, 11.2% of patients (n=22) had pulmonary hypertension (PAH), three of them had cough and/or dyspnea and four of them had hemoptysis as a pulmonary symptom. Among patients with PAH, any pulmonary involvement in CT was more frequent compared to the rest of the patients (22.7% vs 5.1%, p Conclusion In this first assessment of Turkish TAK cohort, we observed non-vascular pulmonary involvement in about 5% of our patients and half of them were pleural effusions. The second most common manifestation was parenchymal infiltration with a frequency of 2%. Although rare, non-vascular pulmonary manifestations should also be investigated in TAK patients, especially in patients with pulmonary hypertension. References [1] Nakajima N. Takayasu Arteritis: Consideration of pulmonary involvement. Ann Vasc Dis2008;1(1):7-10. [2] Elsasser S, Soler M, Bollinger CT, et al. Takayasu disease with predominant pulmonary involvement. Respiration2000;67(2):213-5. Disclosure of Interests Ayten Yazici: None declared, Ayse Cefle: None declared, Sema Kaymaz Tahra: None declared, Nilufer Alpay Kanitez: None declared, Mete Kara: None declared, Onay Gercik: None declared, Handan Yarkan Tugsal: None declared, Fatos Onen: None declared, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Kenan Aksu: None declared, Gokhan Keser: None declared, Fatma Alibaz-Oner: None declared, Haner Direskeneli: None declared

Background In spondyloarthritis (SpA), biologic DMARDs are important treatment options in resistant patients. Inefficacy or side effects may cause switching between these drugs. Objectives This study aimed to determine features of patients switching from one biologic agent to another in SpA treatment and to investigate associated reasons. Methods This multicenter, prospective observational cohort study used the TReasure database in which web-based registration of rheumatoid arthritis and SpA patients are being performed in 15 centers across different regions of Turkey. In this study, data of SpA patients switching from one biologic agent to another were analyzed. Demographic and clinical data, follow-up duration, time to switch, and reasons for switching were retrieved from the database. Kaplan-Meier analysis was performed to show drug retention rates and Cox regression analysis was performed to investigate the factors affecting switching. Results Of the included 3138 SpA patients, 1165 (37.1%) switched to another biologic agent (switched group) and 1973 (62.9%) continued to receive their current therapies (continued group). The median follow-up duration of all patients was 3.8 years and the median time to switch was 1.0 years (0-13.4 years). According to the distribution of comorbidities, the rates of patients having diabetes mellitus, hyperlipidemia, asthma, gastrointestinal bleeding, and cancer were significantly higher in the switched group than those of in the continued group (8.4% vs. 5.8%, p=0.006; 14.5% vs. 9.2%, p In the switched group (n=1165), the main reasons for switching were secondary inefficacy (n=351), primary inefficacy (n=328), and side effects (n=267) followed by primary or secondary unknown inefficacy (n=57), physician’s request (n=45), patient’s demand (n=36), willing to be pregnant (n=9), other (n=37), and unknown (n=70). Conclusion In SpA patients, switching was frequent between anti-TNF agents and the median time to first switch was 1 year. Female gender, short disease duration, and lower BASDAI score were found to be the significant factors affecting switching from the anti-TNF agent used at first. The main reasons for this switching were primary (29.0%) and secondary (31.0%) inefficacy followed by side effects (23.6%). Switching between subcutaneous anti-TNF agents is generally less than switching from infliximab to another biologic agent. Disclosure of Interests Umut Kalyoncu Grant/research support from: MSD, Roche, UCB, Novartis and Pfizer, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Speakers bureau: MSD, Abbvie, Roche, UCB, Novartis, Pfizer and Abdi Ibrahim, Sedat Kiraz: None declared, Abdulsamet Erden: None declared, Orhan Kucuksahin: None declared, Timucin Kasifoglu: None declared, Ediz Dalkilic Grant/research support from: MSD and Abbvie, Consultant for: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Speakers bureau: MSD, Abbvie,Roche, UCB, Pfizer and Novartis, Cemal Bes: None declared, Nilufer Alpay Kanitez: None declared, Hakan Emmungil Grant/research support from: MSD, Roche, Pfizer, Abbvie, Consultant for: Novartis, Roche, Speakers bureau: MSD, Roche, Pfizer, Abbvie,Celltrion, Novartis, Pamir Atagunduz: None declared, Belkis Nihan Coskun: None declared, Burcu Yagiz: None declared, Suleyman Serdar Koca: None declared, Muhammet Cinar: None declared, Askin Ates: None declared, Servet Akar Grant/research support from: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Consultant for: MSD, Abbvie, Roche, UCB, Novartis, Pfizer, Amgen, Speakers bureau: Pfizer, Onay Gercik: None declared, Duygu Ersozlu: None declared, Veli Yazisiz: None declared, Gezmis Kimyon: None declared, Muge Aydin: None declared, Ridvan Mercan: None declared, Burak Oz: None declared, Nazife Sule Yasar Bilge: None declared, Zeynel Abidin Akar: None declared, Omer Karadag: None declared, Ayse Bahar Kelesoglu Dincer: None declared, Sedat Yilmaz: None declared, Ufuk Ilgen: None declared, Yavuz Pehlivan: None declared, Ender Terzioglu: None declared, Levent Kilic: None declared, Sukran Erten: None declared, Ali Ihsan Ertenli: None declared

Osteoporosis, osteosclerosis, and lytic bone lesions have been observed in patients with systemic mastocytosis (SM). We examined bone mineral density (BMD) biochemical turnover markers and serum tryptase levels in SM, which is considered a rare disease.Seventeen adult patients (5 females, 12 males; median age: 33 years, range: 20-64) with mastocytosis were included in this study. We investigated the value of quantitative ultrasound (QUS) of the calcaneus in the assessment of BMD in SM patients, as well as BMD of the lumbar spine (L1-L4), femoral neck, and distal radius using dual energy x-ray absorptiometry (DXA) and plasma tryptase levels, biochemical markers of bone turnover.At lumbar spine L1-L4, the femoral neck, and the distal radius or as calcaneus stiffness, 12 of 17 patients had T-scores of less than -1 at least at 1 site, reflecting osteopenia. Three of 17 patients had T-scores showing osteoporosis (T-score-2.5). There was no relationship between DXA and bone lesion severity. We also found a significant positive correlation between tryptase levels and disease severity, as well as between disease severity and pyridinoline (p0.01 by Spearman's test).DXA and calcaneal QUS may not be appropriate techniques to assess bone involvement in SM patients because of the effects of osteosclerosis. This study further shows that the osteoclastic marker pyridinoline is helpful in patients with severe disease activity and sclerotic bone lesions to show bone demineralization.Amaç: Sistemik mastositozlu (SM) hastalarda osteoporoz, osteoskleroz ve litik kemik lezyonları görülebilir. Bu çalışmada nadir bir hastalık olan SM’de, kemik yoğunluk ölçümü (BMD), serumda kemik ‘turnover’ belirteçleri ve triptaz düzeyi araştırılmıştır. Gereç ve Yöntemler: Çalışmaya 5’i kadın, 12’si erkek olmak üzere median yaşları 33 (20-64) olan toplam 17 hasta dahil edilmiştir. Hastaların BMD’leri lomber vertebra (L1-L4), femur boynu ve distal radiustan dual enerji x-ray absorbitesi (DXA) yöntemi, kalkaneustan ise kantitatif ultrasonografi (USG) yöntemi kullanılarak ayrı ayrı hesaplanmıştır. Serum triptaz düzeyleri ile biyokimyasal kemik ‘turnover’ belirteçlerileri arasındaki ilişki araştırılmıştır. Bulgular: Hastaların 12 tanesinde osteopeni (incelenen kemik alanlarının en az birinde T skoru-1), 3 tanesinde ise osteoporoz (T skoru-2,5) saptanmıştır. Kemik lezyonlarının şiddeti ile DXA sonuçları arasında korelasyon gösterilememiştir. Triptaz ve pridinolin seviyeleri ile hastalık şiddeti arasında pozitif korelasyon bulunmuştur (p0,01). Sonuç: Osteosklerotik kemik lezyonları sebebiyle SM’li hastalarda kemik tutulumu değerlendirmesi için DXA ve kalkaneus USG uygun teknikler değildir. Osteoklastik aktivite belirteçleri olan pridinolin, şiddetli hastalık aktivitesi ve kemik sklerozlarını değerlendirmede faydalıdır.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary renal disease. The course and progression of the disease is highly variable. In this study, we aimed to investigate the impact of clinical characteristics and basic biochemical parameters on progression of chronic kidney disease (CKD) in ADPKD patients. A total of 323 consecutive patients with ADPKD were enrolled into the study and followed with a mean duration of 100 ± 38 months. Patients were grouped as rapid progressors (RP) and slow progressors (SP) according to median rates of decline in glomerular filtration rate (ΔGFR) per year, namely 1 ml/min/year. History of macroscopic hematuria, urinary stone and smoking were more common in male patients; hepatic and other organ cysts were more common in female patients. ∆GFR/year was similar between males and females [0.95 (0–3.02) vs. 1.11 (0.10–2.74) ml/min/year, p = 0.21]. History of smoking and pack-year of cigarettes smoked were significantly higher in the RP compared to the SP group (36 vs. 18 %, p = 0.01 and 5.24 ± 1.20 vs. 3 ± 1.32 pack-year, p = 0.02, respectively). Baseline 24 h-proteinuria was found to be significantly correlated with the percent decline of GFR (∆%GFR) per year (r = 0.303, 0.001). In Cox regression analysis for predicting the progression of CKD, age, hypertension, urinary stone and proteinuria were retained as the significant independent factors predicting progression of CKD in the model. Baseline proteinuria was significantly correlated with ∆%GFR per year. Hypertension and proteinuria were found to be the major treatable risk factors for the progression of CKD in ADPKD patients.

The association of Takayasu’s arteritis (TAK) and inflammatory bowel disease (IBD) has previously been reported in case series. Microscopic colitis (MC) has IBD-like symptoms with regard to clinical and histopathological feature. We aim to assess the presence of MC in TAK patients in this study. We cross-sectionally assessed TAK patients, between the ages of 18–65 years, who were diagnosed according to the American College of Rheumatology (ACR) criteria. Disease activity was evaluated by Kerr’s criteria. Age- and sex-matched irritable bowel syndrome (IBS) patients were selected as control group. All patients and controls have been interviewed for IBD and IBS symptoms using the questionnaires of WHO guideline and Rome III criteria, respectively. Lower endoscopic procedure was performed with at least five random biopsies taken from different colonic segments and the terminal ileum. A blinded expert pathologist evaluated the specimens for the features of MC. Thirty TAK patients (29 females and 1 male) with the mean age of 35 ± 11 years (range, 20–59 years) and 15 IBS controls with the mean age of 38 ± 13 years were included in the study. TAK patients all fulfilled the MC criteria (three “complete” and six “incomplete” cases). MC was found to be significantly higher in active TAK patients in comparison to inactive group (67 vs 14 %, p = 0.03, OR = 7.9). Our results show that there is an increased frequency of MC in TAK patients, and this is the first report on the association of TAK and MC.

Background There is not valid outcome measures for assessment Adult onset Still9s disease (AOSD) activity. The patients or physicians global view is relevant way to assess this kind of complex diseases. However, it is well known that there is discordance between patient and physician perspective for disease activity in different inflammatory diseases. Objectives Objective of this study was to evaluate agreement of patient and physician perspective in AOSD patients. Methods We conducted a cross-sectional, multicenter study for assessment of disease activity in AOSD patients. All AOSD patients were fulfilled Yamaguchi criteria. For every center, at least 20% of AOSD patients had to be an active state according to physician assessment. Age, sex, disease duration, current disease symptoms was recorded. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), leucocyte, and ferritin level also recorded. Visual analog scale (VAS) (0–10 cm) used for physician and patient global assessment of disease activity. Disease activity status were also assessed by likert scale (as remission, low, moderate, severe, and more severe disease activity) for both patients and physician perspective. Patient global assessment VAS and physician global assessment were correlated by correlation coefficient (r). Agreement of disease activity level for patient and physician perspective were calculated with kappa. Kappa >0.6 was accepted as significant. Results One hundred thirty (83, 63.4% female) AOSD patients were enrolled. Mean age was 38 (14) years old and median disease duration was 3 years (0–29). Currently AOSD symptoms followed; fever 34 (26.2%), rash 28 (21.5%), arthritis 31 (23.8%), arthralgia 60 (46.2%), sore throat 28 (21.5), myalgia 42 (32.3), lympadenopathy 12 (9.2%), splenomegaly 17 (13.1%), hepatomegaly 7 (5.4%), pleuritic 3 (2.3%), hemophagocytic syndrome 2 (1.5%). ESR 47.7%, CRP 43.8%, ferritin 27.0%, and leucocyte 43.1% were higher than upper limit. Mean patient global assessment VAS was 3.53 (3.25), and mean physician global assessment VAS was 2.71 (2.95). Correlation coefficient (r) of patient and physican global VAS was 0.89. There was excellent agreement according to severe/more severe disease activity at patient and physician level (kappa 0.88 (CI 95% 0.79–0.98). There was also good to excellent agreement according to low disease activity/remission at patient and physician level (kappa 0.74 (CI 95% 0.62–0.86). Conclusions Although, features of AOSD seems more complex with constitutional symptoms, joint or reticuloendothelial system involvement, patients and physicians assess level of disease activity similarly. We thought, this results will be helpful for procedure of new composite index in AOSD. Disclosure of Interest None declared

symptom but this was similarly reported in both patient groups (15/24 vs 29/42), as were buttock (7/24 vs 9/42), neck (9/24 vs 11/42), knee (5/ 24 vs 8/42), shoulder (5/24 vs 11/42), and foot (6/24 vs 7/42) pain. Crucially, eye inflammation (later diagnosed as uveitis) was reported as a first symptom for 39% (9/24) of uveitis patients. Importantly, hip pain (10/24 vs 10/42; P

Background Hepatitis B (HepB) is an endemic infection in Turkey, with an intermediate risk rate (2-7%). HepB vaccination has long been advised in high risk population, especially in endemic areas. Granulomatosis with poliangiitis (GPA) patients can be considered at high risk due to the requirement of frequent diagnostic and therapeutic upper and lower airway procedures. Objectives We aimed to investigate antibody response and safety profile of HepB vaccination in patients with GPA. Methods Sixty GPA patients who have been regularly followed-up since 1994 were included into the study. They were screened for HepB virus infection by HbsAg, anti-Hbs, anti-HbcIgG serology. Active patients according to BVAS2003 (BVAS≥1) were excluded from the study. The patients who had negative for all 3 tests and inactive disease were involved into the vaccination programme. All but 2 patients had systemic GPA. Two GPA patients receiving moderate dose (≥7,5 mg/d) of glucocorticoid (GC) scheduled to a standardized tapering protocol and meeting remission criteria were also allowed to the study. Recombinant HepB vaccination was applied by im route for each patient at 0, 1th and 6th months. The clinical, laboratory and treatment findings, BVAS scores and adverse events were noted into a predefined protocol and adverse event form at the study visits and ≥1 month after each dose of vaccination. Cumulative doses of immunosuppressive (IS) drugs before 6 months and during the vaccination period were separately calculated. HbsAg antibody response was tested by ELISA method. Positive results were accepted for serum antibody titers >10 IU/ml. Mann Whitney U test was used to compare the demograhic characteristics and the doses of IS between the responders and nonresponders. Results Twenty (12 male, 8 female) GPA patients aged between 22-68 years were found to be eligible for vaccination programme. The patients were on AZA (n=11), MTX (n=3), CYC (n=1), LEF (n=2), MMF (n=1) and RIT (n=2) during the study period. Cumulative GC doses were 1.1±1 (0.3-2) and CYC doses were 0.7±1.8 (0-6), before vaccination. Positive antibody response was detected only in 45% of cohort (>100 IU/ml in 20%). There were no relationship between the antibody response and age, disease duration and IS doses. The antibody response was significantly more frequent in female patients compared to males (75% vs 25%, p=0,02). No significant difference in IS treatment and doses was observed regarding the gender of patients. Mild injection site reactions (10%), myalgia (5%) and fever (5%) were the adverse event related to vaccination. Flare was not observed in any patient during the vaccination period. Conclusions This is the first report on the HepB vaccination in GPA patients. Antibody response to HepB vaccination has been found in lower rates (45%) than the expected in healthy controls (>90%) which may be resulting from intense immunosuppressive treatments for the systemic involvement of this GPA cohort. Female GPA patients have had a notably higher response to HepB vaccination similar to the immunization results in healthy women. The higher or booster doses might be needed for GPA patients, especially for males. Disclosure of Interest None Declared

Background Takayasu’s arteritis (TA) is a large vessel vasculitis of the young women in their reproductive age. It’s been previously reported as having conflicting results on the pregnancy outcome in TA. Objectives Herein, we reported the pregnancy outcome and the effect of the pregnancy on the disease course in a well established TA cohort. Methods TA patients diagnosed by ACR criteria and had the history of pregnancy were included into the study. Clinical and laboratory findings including serum ESR and CRP levels were evaluated both retrospectively and prospectively. Pregnancy and newborn outcome consists of the history of abortus, delivery mode, prematurity, intrauterin growth retardation, preeclampsia and eclampsia that were obtained from medical records. Data were noted into a predefined protocol. Disease activity and damage evaluated by Kerr criteria and VDI and concomittant immunosuppressives were recorded within the 3rd trimester and 6 months of pre and postpartum period in a subgroup prospectively followed-up. Pre-diagnosis (pre-d) and post-diagnosis (post-d) pregnancies were compared according to the maternal and fetal outcome. Results Eighty-two pregnancies in 34 patients were assessed in TA cohort of 103 patients. Only 10% of all pregnancies were planned. Mean (median) age of 34 patients at pregnancy period were 24,5±6,6 (22). Subclavian (85%), carotis (44%) and pulmonary arteries (26%) were the most frequently involved vessels. Hypertension (47%), pulselessness (%34), mild pulmonary hypertension (18%) related to valvular disease (26%) were the prominent clinical features. Comparison of fetomaternal prognosis between the pre-d (63 in 24 TA) and post-d (19 in 15 TA) pregnancies demonstrated that hypertension (3% vs 16%), preeclampsia (0% vs 10%), prematurity (2% vs 10%) and Cesarean section (CS) (9% vs 37%) were significantly high in post-d pregnancies. Eight patients (of 4 newly diagnosed) prospectively followed-up during their pregnancies. Glucocorticoid (GC) (4 pts) and azathioprin (2 pts) were maintained after taking the patients’ consents. Four patients had flare during the 3rd trimester. Two of 4 patients had taken 10 mg/d GC and other 2 patients denied to be treated. The patient had renal artery involvement complicated with preeclampsia and the other experienced accelerated hypertension. Five TA patients underwent Ceaserean section mainly because of the probable risk of cerebral hypoperfusion during the delivery. One TA patient who was exposed to infliximab during the conception, has since been followed-up succesfully at the 3rd trimester under the low dose of GC. There were no obvious fetomaternal abnormality in TA cohort. No flare was observed during the 6th month of postpartum period. VDI scores did not increase in all patients. Conclusions Majority of the pregnancies were found as successfull in a well established TA cohort. Higher rates of preeclampsia, prematurity and CS in post-d pregnancies were attributed to the exposure of GC treatment and physicians’ bias for delivery route. CS and prematurity were found as similar with our healthy population rates. Flares did not cause damage accrual in a short postpartum follow-up period. Flare has to be differentiated from the aberrant physiological changes and acute phase increase during the pregnancy. Close monitorization of arterial tension could be helpful for maintaining succesful pregnancy Disclosure of Interest None Declared

Background Antiphospholipid syndrome (APS) is an autoimmune disease characterised by recurrent arterial or venous thrombosis, pregnancy morbidity and the persistence of positive antiphospholipid antibodies (aPLA). The selectins are cell adhesion molecules that mediate the interaction among leukocytes, activated platelets and endothelial cells. P-selectin, which can be identified as soluble form in plasma, intercedes the attachment and rolling of leukocytes on activated endothelial cells, and is involved in the recruitment of leukocytes to thrombi. Objectives We aimed to investigate whether P-selectin polymorphisms are associated with thrombosis in patients with APS. Methods Fourty adult patients with APS and 40 healthy subjects as controls with no history of thrombosis or autoimmune diseases were included into the study. The diagnosis and classification of APS were based on the report of an international workshop. The subjects participating in the study had no systemic lupus erythematosus and the risk factor such as hypertension or hyperlipidemia for thrombosis. Genomic DNA was extracted from citrated blood samples of all subjects. Three single nucleotide polymorphisms associated with P-selectin coding region (S290N, c.1087G>A; D562N, c.1902G>A; T715P, c.2363A>C) were assessed. Results There were 26 APS (65%) patients with thrombosis involved vein, artery, vein and artery together respectively; 12 (46%), 10 (38%) and 4 (15%). The number of patients without thrombosis was 14 (35%). The mean age of patients (92% female) was 39,4±9,5. The frequency of D562N-DN genotype was significantly higher in patients with APS than healthy controls (p: 0,003). The frequency of this genotype was significantly higher in patients with APS with thrombosis compared with patients with no thrombosis (p:0,03). D562N-NN genotype was found at a higher frequency in patients with APS than healthy controls (p:0,004). The frequency of D562N-NN genotype was comparable between patients without thrombosis and controls (p:0,21). On the other hand, S290N and T715P polymorphisms were similar in all subjects (Table). No relationship was found between APLA, thrombocytopenia or fetal loss and P selectin polymorphisms. Conclusions Our results suggest that D562N polymorphism DN genotype of P-selectin is associated with an increased risk of thrombosis in patients with APS. NN genotype of the same polymorphism might be protective for thrombosis in those patients. The effect of D562N polymorphism on soluble P-selectin levels will be studied in the next step. Disclosure of Interest None Declared